J. Deneen

The Multi-Ethnic Pediatric Eye Disease Study: Design and Methods

Purpose: To summarize the study design of the Multi-Ethnic Pediatric Eye Disease Study (MEPEDS). Methods: The objectives of the MEPEDS are to: (1) estimate age- and ethnicity-specific prevalence of strabismus, amblyopia, and refractive error; (2) evaluate the association of selected risk factors with these ocular disorders; and (3) evaluate the association of ocular conditions on limitations in health-related functional status in a population-based sample of 12,000 children aged 6–72 months from four ethnic groups—African-American, Asian-American, Hispanics/Latinos and non-Hispanic White. Each eligible child undergoes an eye examination, which includes an interview with his/her parent. The interview includes an assessment of demographic, behavioral, biological, and ocular risk factors and health-related functional status. The examination includes fixation preference testing, visual acuity, stereoacuity, axial length measurement, cycloplegic refraction, keratometry, eye alignment, and anterior and posterior segment examination.

Burden and Predictors of Undetected Eye Disease in Mexican-Americans : The Los Angeles Latino Eye Study

Background:Latinos have one of the highest rates of visual impairment associated with eye disease in the United States. Although little is known about the prevalence and risk of undetected eye disease (UED) in this population, it is known that Latinos encounter disproportionate barriers in accessing health care, which may influence the burden of UED. Objective:To estimate the burden and to evaluate factors associated with UED among Latinos, a majority of whom were Mexican-American. Research Design:Population-based, cross-sectional study. A detailed interview and eye examination were performed on participants. Subjects:A sample of 6357 Latinos (95% of whom had Mexican ancestry), aged ≥40, in 6 census tracts in Los Angeles, California. Main Outcome Measure:UED (macular degeneration, glaucoma, diabetic retinopathy, cataract, and refractive error) was defined as those persons with eye disease and no reported history of that eye disease. Results:Fifty-three percent (3349 of 6357) of the participants had eye disease. Sixty-three percent (2095 of 3349) of them had UED. Major risk factors for UED included older age [odds ratio (OR): 4.7 (age ≥80)], having diabetes mellitus (OR: 3.3), never having had an eye examination (OR: 2.4), being uninsured (OR: 1.6), lower educational attainment (OR: 1.4), and low acculturation (OR: 1.3). Conclusions:These findings provide evidence of the burden of UED among Latinos. Interventions that address the modifiable risk factors (lack of insurance, never having had an eye examination, etc.) may improve detection of eye disease and decrease the burden of visual impairment in this high-risk minority population.

Testability of the Retinomax autorefractor and IOLMaster in preschool children: the Multi-ethnic Pediatric Eye Disease Study.

PURPOSE To determine the testability of Retinomax and IOLMaster ocular biometry in preschool children. DESIGN Population-based study of inner city preschool children in Los Angeles County. PARTICIPANTS Two thousand five hundred forty-five Hispanic and 2178 African American children 6 to 72 months old. METHODS Subjects were identified by door-to-door screening within previously identified contiguous census tracts. Pediatric ophthalmologists or optometrists performed comprehensive eye examinations on all subjects. Refractive error and keratometry measurements were attempted on all subjects with the Retinomax autorefractor after cycloplegia. Axial length measurements with the IOLMaster partial coherence interferometer were attempted on those subjects ages 30 to 72 months. MAIN OUTCOME MEASURES Ability to obtain high confidence autorefraction readings or axial length measurements on both eyes. RESULTS Overall, 89% were testable in both eyes with the Retinomax device, and 91% of the children were testable with the IOLMaster. Testability rose sharply with age, so that by age 36 months 98% of children were testable with the Retinomax device and 90% were testable with IOLMaster. There were no consistent gender- or ethnicity-related differences in testability overall or when stratified by age for either device. CONCLUSIONS Young children can be reliably tested for ocular biometry with the Retinomax and IOLMaster devices. This may impact strategies for management of cataracts and refractive errors in preschool children.

Stereoacuity testability in African-American and Hispanic pre-school children.

Purpose. To determine testability using the Randot Pre-school Stereoacuity Test in black and Hispanic children 30 to 72 months of age. Methods. A population-based cohort of children 30 to 72 months of age was administered the Randot Pre-school Stereoacuity Test, with presenting refractive correction, and before cover testing, visual acuity testing, or refraction. Children who could not point to specified two-dimensional demonstration pictures, and children who would not try to name or match random dot figures to the corresponding two-dimensional pictures, were classified as unable to perform the test. Children who were able to perform the task but could not correctly identify at least two 800-arcsecond random dot figures were classified as having no stereopsis, and were retested by another examiner. Results. Stereoacuity testing was attempted in 1662 Hispanic and 1470 black children. Overall, 80% of children were able to be tested; 33% of children 30 to 36 months of age, 73% of children 37 to 48 months of age, 96% of children 49 to 60 months of age, and 98% of children 61 to 72 months of age were testable. Older children were significantly more likely to complete testing successfully than younger children (p < 0.0001). After adjusting for age, there was no significant ethnicity-related difference in testability (p = 0.19); however, there was a small but significant gender-related difference (p = 0.0002) with more girls (82%) than boys (77%) able to complete testing. Conclusions. Eighty percent of children aged 30 to 72 months can be tested using the Randot Pre-school Stereoacuity test. Testability increases steadily with age, and 97% of children over 48 months of age can complete the test. Testability does not differ between children of Hispanic and black ethnicity.

Visual acuity norms in pre-school children

Purpose. To provide population-based normative data for monocular visual acuity (VA) and interocular differences in VA (IOD) in Black and Hispanic children 30 to 72 months of age without visually significant refractive errors or ophthalmic abnormalities. Methods. In a population-based cohort of children in the Multi-Ethnic Pediatric Eye Disease Study, monocular HOTV VA measurements using the Amblyopia Treatment Study protocol were analyzed using continuous and dichotomous outcomes for VA and IOD, after excluding subjects with ophthalmic abnormalities or refractive error. Results. The analysis cohort consisted of 1722 Black and Hispanic children aged 30 to 72 months. Mean logMAR VA improved with age (p < 0.0001) and male gender (p = 0.0008). The proportion of children achieving VA 20/40 or better was associated with age (p < 0.0001), but not ethnicity or gender, and was 81, 94, 99, and virtually 100% in children aged 30 to 35, 36 to 47, 48 to 59, and 60 to 72 months of age, respectively. The most stringent VA threshold that excluded <5% of normal children was 20/63, 20/50, 20/32, and 20/32 for children aged 30 to 35, 36 to 47, 48 to 59, and 60 to 72 months, respectively. Children attending preschool or daycare achieved VA 20/32 more often than those not attending, after age adjustment (p = 0.01), as did children from higher-income families (p = 0.04). There was no association between mean absolute IOD and age (p = 0.45), ethnicity (p = 0.12), or gender (p = 0.19). The proportion of children with an IOD of 0 to 1 lines was higher in males than females (p = 0.02); it did not vary by age (p = 0.06) or ethnicity (p = 0.17). An IOD of 2 or more lines occurred in 6% of normal children. Conclusions. VA test performance in normal pre-school children improves with age. We propose new age-specific thresholds for defining abnormal monocular VA using HOTV optotypes in children between 2 and 5 years of age, for use in screening, clinical practice, and research.